Pelvic support abnormalities and urinary incontinence Flashcards
What are the key pelvic support abnormalities?
cystocele
rectocele
enterocele
vault prolapse
What is a cystocele?
A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina.
What is a rectocele?
A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina.
What is a enterocele?
An enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal
What is a vault prolapse?
Vaginal prolapse is a condition in which the vagina, or structures near it begin to prolapse, or fall out of its normal position
What is the principal etiology of a cytocele and rectocele?
vaginal delivery
What is the principal etiology of a enterocele and vault prolapse?
prior hysterectomy
What are the clinical manifestations of a cystocele?
sense of prolapse, vaginal pressure, urinary incontinence
What are the clinical manifestations of a rectocele?
sense of prolapse, rectal pressure, entrapped stool
What are the clinical manifestations of a enterocele?
sense of prolapse, dyspareunia
What are the clinical manifestations of a vaginal prolapse?
sense of prolapse, dyspareunia, perineal pain, vaginal infection
How do you manage a cystocele?
pessary surgery- may cause incontinence
How do you manage a rectocele?
stool softeners, laxatives; surgery- may cause dyspareunia
How do you manage a enterocele?
pessary surgery
How do you manage a vault prolapse?
pessary surgery- resuspend vault or close the vagina
What goes into the differential diagnosis of urinary incontinence?
overflow incontinence (neurogenic bladder)
urge incontinence
stress incontinence
What are possible etiologies of overflow incontinence?
neurologic disorder (MS, MD)
spinal cord injury
diabetes
What are possible etiologies of urge incontinence?
anxiety
infection
polyp
tumor
what are possible etiologies of stress incontinence?
childbirth (especially vaginal delivery)
prior pelvic surgery (repair of cystocele)
estrogen deficiency
What are common characteristics of overflow?
no sense of urgency, loss occurs when bladder is overfilled
What are common characteristics of urgency?
immediate sense of needing to void
What are common characteristics of stress?
precipitated by coughing, sneezing, straining or exercising
How do you evaluate urinary incontinence?
physical exam- identify neuromuscular disease
urine culture- exclude infection
cystoscopy- evaluate for polyps, tumor, inflammation
urodynamic testing- confirm stress incontinence
What is the proper management of overflow incontinence?
treatment of underlying condition
treatment and prevention of infection
catherterization as indicated
What is the proper management of urge incontinence?
reduce weight
stop smoking
decrease, if not eliminate, caffeine intake
re-train bladder
medication- muscarinic receptor blockers (oxybutynin-ER 5-15 mg daily)
What is the proper management of stress incontinence?
lose weight
avoid caffeine
re-train bladder
empty bladder immediately before exercising
Surgical:
trans-abdominal procedure, rarely used today
transvaginal procedure (TVT, TOT)
Collagen injection
Which incontinence usually requires surgery?
stress
Which incontinence responds the best to medical therapy?
urge
